Clinical relevance of transient worsening renal function after initiation of sacubitril/valsartan

Abstract

Background

The worsening of renal function after the start of valsartan therapy is relatively common in clinical practice. However, few data are available on the incidence of worsening renal function after the beginning of therapy with sacubitril/valsartan.

Methods

We retrospectively enrolled 202 outpatients with HFrEF that started therapy with sacubitril/valsartan to evaluate the prevalence of worsening renal function and its clinical significance.

Results

At 1 month, a worsening renal function (defined as a > 20% decrease in eGFR occurring after 1 month of ARNi therapy) was found in 68 patients (33%), however after a mean follow-up of 650 ± 80 days, Kaplan–Meier analysis showed no significant in terms of HF-related deaths, HF-related hospitalizations, and the need for renal replacement therapy (25.2 vs. 23.6%; p = .812). In addition, the renal function recovered in patients with early WRF at 3 months (62 + 9.3 ml/min/1.73 m² vs. 63 ± 13.8 ml/min/1.73 m²; p < .05), with an improvement in estimated glomerular filtration rate at 1 year compared with baseline value (62 ± 9.3 ml/min/1.73 m² vs. 69 ± 8.6 ml/min/1.73 m²; p < .01).

Conclusions

WRF occurs in nearly 30% of HFrEF patients without impacting clinical outcomes; HF specialists should be aware of these changes to avoid unnecessary discontinuation of sacubitril/valsartan therapy.

Keywords:

• Sacubitril-valsartan
• glomerular filtration rate
• heart failure
• worsening renal function

Transparency

Declaration of funding

This study was not funded.

Declaration of financial or other relationships

DM, EM, VE, FV and GP declare no competing interests. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conceptualization: DM and GP. Data curation: VE, EM, FV. Writing- original draft preparation: DM and FV. Writing- review and editing: DM, EM, GP. All authors have read and agreed to the published version of the manuscript.

Acknowledgements

None stated.

Data availability statement

The data that support the findings of this study are available from the corresponding author, D.M., upon reasonable request.